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作者：CardiothoracicSurgery
*仅供医学专业人士参考
手术赋予局限期小细胞肺癌患者生存优势:一项全国性分析
AATS 2023
原文标题：
Surgery Confers a Survival Advantage in Limited-Stage Small Cell Lung Cancer: A National Analysis
作者及单位：
Chi-Fu Yang., Invited Discussant, Massachusetts General Hospital
Sara Sakowitz, Abstract Presenter, David Geffen School of Medicine at UCLA
简介
目的：
由于小细胞肺癌（SCLC）通常具有系统性和较晚的发病时间，手术切除在SCLC的多模式治疗中的作用仍存在争议。本研究使用全国代表性的队列研究，评估手术切除对限制性小细胞肺癌患者的总生存率的影响。
方法：
使用2004-2017年国家癌症数据库，鉴定所有符合AJCC指南中手术切除资格的限制性I-IIA SCLC患者，手术定义为肺叶切除、肺切除或肺切除术。接受手术切除的患者组成手术组（其他：无手术）。使用Cuzick非参数检验评估切除率的时间趋势。使用Cox比例风险模型评估时间调整后的生存率，使用Kaplan-Meier生存曲线构建未调整的五年生存率。最近邻倾向匹配被用于产生平衡队列以进行风险调整敏感性分析。
结果：
在16,842例I-IIA期患者中，有2,598例（15.4％）接受了手术切除治疗。随着时间的推移，接受手术切除治疗的患者比例增加（2.89％至11.16％，nptrend <0.001）。
相对于未接受手术的组，手术组年龄更年轻（68岁VS 70岁），而且更频繁被诊断为IA期疾病（65.6％VS 39.3％，p <0.001），但平均 Charlson 合并症评分相似（0.66 VS 0.67，p = 0.53）。在风险调整后，手术与死亡风险的相对风险减少了44％（AOR 0.56，95％CI 0.51-0.61）。在评估每个分期下切除对结果的影响的子集分析中，发现类似的结果。此外，手术切除与+16.37个月的生存时间增加有关（95％CI 15.00-17.74）。在一项近邻倾向匹配敏感性分析中，手术仍然与降低死亡率的可能性有关（AOR 0.47，95％CI 0.35-0.64）。
结论：
本研究通过一项全国性的队列研究表明，手术切除明显有益于患者预后，应被作为早期SCLC疾病管理的主要手段之一。尽管随着研究时间的推移，接受手术治疗的患者比例增加，但手术切除仍然是一种明显被低估的方法。考虑到当前这些患者的低下中位生存期，有必要开展研究评估手术的最佳时机。
作者简介：
Chi-Fu Yang
Invited Discussant
Dr. Chi-Fu Jeffrey Yang is a thoracic surgeon at Massachusetts General Hospital and an Assistant Professor of Surgery at Harvard Medical School. He received his medical degree at Harvard Medical School. He completed his general surgery residency at Duke University and cardiothoracic surgery fellowship at Stanford University Medical Center.
Dr. Yang practices all aspects of thoracic surgery. He specializes in minimally invasive techniques, including using VATS and robotic approaches. Dr. Yang has received numerous awards, including recognition for exceptional accomplishment in both clinical care and in teaching. In 2021, he received the Harvard Medical School Charles McCabe Faculty Prize for Excellence in Teaching.
Dr. Yang’s research focus is in the field of thoracic oncology and he performs clinical research. He is the recipient of the 2021 AATS Foundation Surgical Investigator Award. Dr. Yang has been the lead or senior author on several high impact papers published in the Journal of Clinical Oncology, Lancet Respiratory Medicine, Journal of Thoracic Oncology, Annals of Surgery, and Chest. He has written over 100 publications, including over 60 as first-, co-first or senior author. Dr. Yang is an editorial board member of the Journal of Thoracic and Cardiovascular Surgery, the Journal of Thoracic Diseases, and the Society of Thoracic Surgeons Online Curriculum.
Dr. Yang is also focused on raising awareness of lung cancer screening. He started the American Lung Cancer Screening Initiative, a 501(c)(3) non-profit, which has worked with communities across 50 states to highlight the importance of lung cancer screening. In 2020 and 2021, he co-drafted resolutions, S. Res. 780 and S. Res. 426, to raise awareness for lung cancer and lung cancer screening that passed in the U.S. Senate, by unanimous support from all 100 U.S. Senators. In 2021, he received the Harvard Medical School Dean's Community Service Faculty Award in recognition of his efforts.
Sara Sakowitz
Abstract Presenter
Sara is a current medical student at the David Geffen School of Medicine at UCLA.
如有不足请指正
（翻译及审校：杨明辉 ）
END
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原文地址：http://mp.weixin.qq.com/s?src=11×tamp=1684075997&ver=4528&signature=hSjlWpXGFIRXXq5-NUuBON9WV9igYrCcyfC3RYcRmhcoXtEJSciiWJaVKIeRn5Tz2bdmaYq7RFDkIaiqeeXByY1I4bF0*D7giHtJn3OE2jF4XMQlOAUIeLO1qAO8bmqu&new=1 |
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